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Someday, even doctor visits could be among the conveniences offered via the Internet. In a comparison of desktop videoconferencing to conventional face-to-face general medical evaluations, patients found virtual visits similar to face-to-face visits on most measures. This study suggests that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care services.

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Travelers book plane tickets online, bank customers can check their accounts at any computer, and busy families can grocery shop online. Someday, even doctor visits could be among the conveniences offered via the Internet. Researchers considering the feasibility and effectiveness of virtual doctors visits report that patients and physicians found that evaluations done through videoconferencing were similar to face-to-face visits on most measures, according a new study.

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"There is growing evidence that the use of videoconferencing in the medical environment is useful for a variety of acute and chronic issues," says Ronald F. Dixon, MD, an internist at Massachusetts General Hospital and the study's senior author. "Videoconferencing between a provider and patients allows for the evaluation of many issues that may not require an office visit and can be achieved in a shorter time."

The healthcare delivery model in the United States is under scrutiny. Reduced access to providers, rapidly increasing costs and an aging population represent major challenges for the healthcare system. Telemedicine projects, including virtual visits (a patient-physician real-time encounters using videoconferencing technology) are being examined to evaluate their capacity to improve patient access to care and lower healthcare costs.

This study, the largest trial of virtual visits versus face-to-face visits done to date, randomized patients to one of two arms. In the first arm, the patients completed a visit (virtual or face-to-face) with a physician; they then completed a second visit via the other modality with another physician. In the second arm of the study, subjects had both visits face-to-face with two different physicians. All physicians and patients completed evaluation questionnaires after each visit.

Patients found virtual visits similar to face-to-face visits on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction. Physicians scored virtual visits similar to face-to-face visits on measures including history taking and medication dispensing. Though they were less satisfied on measures of clinical skill and overall satisfaction, those ratings were still in the good to excellent range.

The diagnostic agreement between physicians was 84 percent between face-to-face and virtual visits; it was 80 percent between the two face-to-face visits.

"The tradition of medicine is to lay hands on the patients, which has always been considered paramount to patient care in the minds of physicians," says Dixon. "However, these findings suggest that virtual visits could be a viable option in circumstances where patients need to be monitored routinely for chronic conditions like diabetes, hypertension, obesity or depression, and where self-management strategies are not working. Virtual visits may also be effective for triage of acute, non-urgent issues like back pain or respiratory infections."

Among the benefits of virtual visits are reduce overhead costs for a physicians' practices by reducing the space and resource requirements. For patients, a virtual visit can minimize time taken away from work and transportation costs. The study suggests that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care.

The co-author of this study is James E. Stahl, MD, internist and technology adoption researcher at Massachusetts General Hospital. The study was supported by the Center for the Innovation of Medicine and Innovative Technology (CIMIT) and the MGH Department of Medicine.

This research was published in the May issue of the Journal of Telemedicine and Telecare.

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